Common Medicare and Medicaid Enrollment Mistakes and How To Avoid Them

Navigating Medicare and Medicaid provider enrollment can be overwhelming, and it’s not uncommon to feel lost in the sea of regulations and requirements. With so many potential pitfalls, it’s important to arm yourself with knowledge to avoid making costly mistakes.

From incurring penalties and gaps in coverage to denied claims and general confusion, there are several consequences to improper enrollment. The good news is that by staying informed and seeking assistance when necessary, you can successfully navigate the complex world of Medicare and Medicaid.

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Common Medicare and Medicaid Enrollment Mistakes

Getting started on the right foot with Medicare and Medicaid can be challenging. By carefully navigating the application process — and double-checking every detail — you can avoid application delays or even denial caused by the following enrollment mistakes.

Prior to Submitting Medicare Enrollment Application

The provider enrollment process is tedious, and Medicare and Medicaid enrollment are no different. Medicare says that applications submitted online through the PECOS system are processed 15 days faster on average, so that’s a great starting place. But, before you submit, here are the most common enrollment mistakes:

• Failing to include the documents requested (including Form CMS-588 and Form CMS-460)
• Providing mismatched addresses or incorrect NPI (National Provider Identification) numbers
• Incorrect reporting of ownership information (CHOW form, IRS ownership documentation)
• Applying with the incorrect enrollment type (and accompanying form)
• Not checking for exclusions just before submittal (they can surface anytime!)

In addition to these Medicare and Medicaid enrollment mistakes, it can also delay your application if CMS needs to contact another agency (such as the IRS or OIG) to question or verify information. Do you best to resolve any issues with these agencies, or related to your social security number or tax identification number, prior to submitting the enrollment application. They’re sure to cause delays in processing!

Staying ahead of the details and building in extra time can help your Medicare provider enrollment process to go smoothly and avoid wasted time and hassle later.

Get a checklist with tips for Medicare enrollment.

After Submitting Medicare Enrollment Application

Don’t make any changes after you’ve submitted your application on the PECOS online system. If edits are made before all signatures are received, PECOS Logging and Tracking (L&T) is locked and the application can’t be processed. That can be a big mistake!

Another common mistake is failing to respond in a timely manner to your Medicare Administrative Contractors (MACs) when they ask for additional information or clarification. This can can lead to delays in processing the application. You may want to include automated reminders in your credentialing software to follow-up with your MAC periodically so you know right away if there is an issue or additional information is needed.

As you’re waiting for a decision on your enrollment, make sure to keep both the provider and your organization’s leadership informed of progress – and set expectations for how long the process could take. You can use your organization’s credentialing data to more accurately predict processing time so you can better prepare them for potential delays.

Maintain Your Status as a Compliant Medicare/Medicaid Provider

Successfully enrolling providers with Medicare and Medicaid is just the first step in the relationship. Now, you need to be sure both the provider and your organization adhere to all related regulations. The two most common areas of concern are related to fraud and billing. Understanding the regulations set forth by these payers and implementing policies and processes that reflect these regulations will keep your organization compliant.

Common errors in billing and claims include:

• Failing to hire competent and qualified personnel to handle billing and claims
• Failing to implement changes based on errors found in billing reviews
• Failing to support claims with necessary documentation — or referencing incorrect documentation when creating claims
• Coding claims incorrectly
• Submitting claims for services or patients outside of Medicare/Medicaid coverage

To maintain your status as a Medicare provider, revalidation is required every five years for most provider types and every three years for DME providers. Missing these deadlines can cause disruption in patient care. To stay ahead, search the Medicare Revalidation List on for individual or organizational providers. Revalidation dates are posted seven months in advance, but taking advantage of automated reminders through credentialing software will ensure both you and the provider are ready when revalidation approaches. If your software includes automated credentialing packets, then all the information should be good to go if the provider has submitted updated licenses or certifications – they’re automatically added to the packet.

How Technology Supports Medicare and Medicaid Enrollment

Credentialing and enrollment software incorporates automation and standardized workflows that speed up the process. Here’s some of the automation you should look for:

• Automated form fill and extraction: Upload forms to the provider enrollment software and data is automatically extracted and stored, then when you’re ready to complete the Medicare provider application, AI-powered mapping takes care of that for you in seconds.
• Automated reminder emails: Add Medicare revalidation dates to the software for automated reminders to both the credentialing specialist and the provider, so you don’t miss the deadline – CMS does no offer extensions!
• Automated license verification: Rely on credentialing software to access original sources on demand and populate license data and an image right within the platform.

The real-time reports and dashboards available in credentialing platforms offer incredible insight to the process so you know how long Medicare provider enrollment takes on average for your organization. They’re also a great way to identify gaps, process improvements, and documents ready to expire.

Ready to tackle Medicare credentialing? Contact MedTrainer to speed up your process.